Exercise Snacks for Type 2 Diabetes

Overseen By Jonathan P Little, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of British Columbia

Must not be taking: Beta-blockers

Disqualifiers: Cardiac disease, Hypertension, Psychiatric disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 12 weeks

80 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how short bursts of vigorous exercise, known as "exercise snacks," can help manage type 2 diabetes. The goal is to determine if performing these exercises four times a day can improve blood sugar control and fitness. Participants may either engage in these exercise snacks or low-intensity stretching for comparison. Ideal candidates for this trial have type 2 diabetes, exercise less than 150 minutes weekly, and take specific diabetes medications. As an unphased trial, this study provides a unique opportunity to contribute to innovative diabetes management strategies.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you must be on a stable dose of up to 3 glucose-lowering medications (not including insulin) and up to 2 cardiovascular medications for more than 6 months to participate.

What prior data suggests that this exercise intervention is safe for adults with type 2 diabetes?

Research has shown that exercise, including short bursts called "Exercise Snacks," is generally safe for people with type 2 diabetes when done with proper guidance. Exercise Snacks involve quick, intense activities performed several times a day. Studies indicate these can improve heart and metabolic health by increasing fitness levels and lowering bad cholesterol. Although Exercise Snacks are safe, participants must follow instructions carefully to prevent injury. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Exercise Snacks as a unique approach to managing Type 2 diabetes. Unlike traditional treatments that mainly involve medication like metformin or insulin, Exercise Snacks use short bursts of vigorous-intensity exercises performed multiple times a day. This method promises to improve blood sugar control without the need for drugs, making it an appealing option for those looking to manage their diabetes through lifestyle changes. Additionally, it offers a more accessible and flexible routine compared to longer, less frequent exercise sessions, potentially increasing adherence and long-term health benefits.

What evidence suggests that this trial's treatments could be effective for type 2 diabetes?

This trial will compare "exercise snacks," short bursts of intense exercise, with a placebo exercise regimen. Research has shown that exercise snacks can greatly improve health in people with type 2 diabetes. Studies have found that these exercises increase aerobic fitness, reduce body fat and waist size, and improve blood pressure and cholesterol levels. Importantly, exercise snacks can help control blood sugar, possibly offering an alternative to medication for managing high sugar levels in type 2 diabetes. Overall, evidence supports exercise snacks as an effective way to enhance health for those with type 2 diabetes. ^{3 4 6 7 8}

Who Is on the Research Team?

Jonathan Little, PhD

Principal Investigator

University of British Columbia

Are You a Good Fit for This Trial?

Adults aged 30-75 with type 2 diabetes, HbA1c ≤8.5%, physically inactive, and not on extreme diets or certain medications can join this study. They must be able to use technology for the program and not have conditions like severe heart disease, recent cardiovascular events, or psychiatric disorders that interfere with exercise.

Inclusion Criteria

HbA1c ≤8.5%

Able to maintain current physical activity patterns during the study

Physically inactive (performing <150 min moderate-to-vigorous physical activity per week)

Exclusion Criteria

I am taking beta-blockers that may affect heart rate tests.

Angina upon exertion assessed by the Rose Angina Questionnaire

Currently following an extreme diet (e.g., very low carbohydrate/calorie, ketogenic) or taking dietary/nutritional supplements that impact glucose control (e.g., exogenous ketones)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-intervention Meeting

Participants have a meeting to document physical limitations and discuss the prescribed intervention

1 week

1 visit (in-person or virtual)

Treatment

Participants perform either vigorous-intensity bodyweight exercises or low-intensity stretching exercises for 12 weeks

12 weeks

Delivered via app or web platform

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Exercise Snacks

Trial Overview The trial is testing 'exercise snacks,' short bursts of physical activity facilitated by technology over a period of 12 weeks. Participants are randomly placed into two groups: one doing these exercises and another performing placebo activities to compare effects on blood sugar control and fitness.

How Is the Trial Designed?

Group I: Exercise Snacks Experimental Treatment 1 Intervention

Vigorous-intensity bodyweight exercises performed 4 times per day on at least 5 days per week.

Group II: Placebo Exercise Active Control 1 Intervention

Low-intensity stretching exercises performed 4 times per day on at least 5 days per week.

Who Is Running the Clinical Trial?

University of British Columbia

Lead Sponsor

Trials

1,506

Recruited

2,528,000+

McMaster University

Collaborator

Trials

936

Recruited

2,630,000+

Published Research Related to This Trial

Exercise can greatly benefit people with diabetes, but it's crucial to measure glucose levels before starting to ensure safety during workouts.

Guidelines have been developed to help exercise specialists determine when to start or stop exercise based on glucose levels, with specific contraindications such as low glucose (<4.0 mmol/L) or high glucose (>15.0 mmol/L with symptoms).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resources to Guide Exercise Specialists Managing Adults with Diabetes. Turner, G., Quigg, S., Davoren, P., et al.[2020]

Short bursts of intense exercise ('exercise snacks') before meals significantly improved blood glucose control in individuals with insulin resistance, showing a reduction in post-meal glucose levels compared to traditional continuous exercise.

Both exercise snacking and a combination of exercise snacking with resistance training were equally effective in lowering overall glucose levels, suggesting that brief, intense workouts can be a practical strategy for managing blood sugar.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

'Exercise snacks' before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance. Francois, ME., Baldi, JC., Manning, PJ., et al.[2022]

Regular physical exercise is crucial for both preventing and treating type 2 diabetes, leading to benefits such as improved insulin sensitivity, better glycemic control, and enhanced cardiovascular health.

Before starting an exercise program, individuals with type 2 diabetes should undergo a thorough medical evaluation to assess their cardiovascular health and any complications, ensuring a safe and effective exercise plan that gradually increases in intensity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diet and exercise in type 2 diabetes mellitus. Hamdy, O., Goodyear, LJ., Horton, ES.[2019]

Individuals with impaired fasting glucose (IFG) had consistently higher glucose levels compared to healthy individuals after consuming different preexercise snacks, indicating a potential risk for glucose management in this population.

Raisins as a preexercise snack resulted in lower post-exercise glucose and insulin responses compared to a glucose solution, suggesting that they may be a better option for managing blood sugar levels in people with IFG.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Glycemic and insulinemic responses to different preexercise snacks in participants with impaired fasting glucose. Byrne, HK., Kim, Y., Hertzler, SR., et al.[2019]

In a study involving five insulin-dependent diabetics, exercising after fasting led to stable plasma glucose levels during exercise, but hypoglycemia occurred 1 to 2 hours post-exercise, highlighting the need for effective pre-exercise snacks.

Three different pre-exercise snacks (orange juice, whole milk, and skim milk) containing 13 g of carbohydrates were effective in preventing hypoglycemia, with orange juice and skim milk providing quicker glucose absorption and higher plasma glucose levels during exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Programming pre-exercise snacks to prevent post-exercise hypoglycemia in intensively treated insulin-dependent diabetics. Nathan, DM., Madnek, SF., Delahanty, L.[2019]

Exercise snacks, which are short bursts of physical activity, can effectively reduce sedentary behavior and promote regular exercise habits, making them a practical solution for overcoming barriers to physical activity.

Research shows that exercise snacks are safe and beneficial for various populations, including the elderly and individuals with obesity or diabetes, as they improve physical function, reduce fall risk, and enhance cardiorespiratory fitness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Applying an Exercise Snack-Based Health Promotion Strategy]. Huang, CH., Yen, M.[2023]

Light aerobic exercise for 60 minutes or moderate exercise for 20-30 minutes, starting 30 minutes after a meal, can effectively reduce postmeal glucose surges with minimal risk of hypoglycemia, based on a review of 39 studies over 30 years.

Incorporating moderate-intensity resistance exercise 2-3 times a week can further help in managing glucose levels, while high-intensity exercise may lead to unpredictable glucose fluctuations and requires further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercising Tactically for Taming Postmeal Glucose Surges. Chacko, E.[2023]

In a study involving six patients with type 2 diabetes, three types of 20-minute moderate-intensity exercises (WB-EMS, RES, and END) were found to reduce postprandial glucose levels after meals, indicating that exercise can help manage blood sugar spikes.

While all exercise types showed similar effects on glucose levels over time, cycling endurance exercise (END) suggested a potential superior effect during the post-exercise recovery phase, although this was not statistically significant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Acute Resistance Exercise with and without Whole-Body Electromyostimulation and Endurance Exercise on the Postprandial Glucose Regulation in Patients with Type 2 Diabetes Mellitus: A Randomized Crossover Study. Holzer, R., Schulte-Körne, B., Seidler, J., et al.[2022]

In a 3-year study involving 300 patients with type 2 diabetes, behavioral counseling led to significant increases in physical activity and decreases in sedentary time, which were associated with improved physical fitness and reduced cardiovascular risk factors.

Modest increases in moderate- to vigorous-intensity physical activity (MVPA) resulted in clinically meaningful improvements, such as a decrease in HbA1c levels and enhanced cardiorespiratory fitness, highlighting the importance of even small changes in activity levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2). Balducci, S., Haxhi, J., Sacchetti, M., et al.[2023]

High-intensity training has been shown to significantly improve metabolic parameters in patients with pre-diabetes and type 2 diabetes, highlighting the importance of exercise therapy for glycemic control.

For patients unable to engage in traditional exercise due to complications, non-exercise activity thermogenesis (NEAT) can be beneficial, providing an alternative way to enhance metabolic health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise Therapy for Patients With Type 2 Diabetes: A Narrative Review. Yanai, H., Adachi, H., Masui, Y., et al.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12380701/

The effectiveness of exercise snacks as a time-efficient ... By assessing 27 trials encompassing 11 distinct CMH outcomes, we found that ES significantly improved nine cardiometabolic indicators VO2max, BF%, WC, SBP, DBP, ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S2666337624000283

Review Exercise snacks and physical fitness in sedentary ... Exercise snacks represents a time-efficient approach with the potential to improve physical activity levels in sedentary populations.

3. frontiersin.org frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1643153/pdf

The effectiveness of exercise snacks as ... Objectives: Exercise snacks (ES) are short bursts of intensive exercise done at regular intervals during the day.

4. facebook.com facebook.com/BJSM.BMJ/posts/-exercise-snacks-small-bouts-big-benefits-new-bjsmblog-summarising-this-recent-s/1146171874324237/

🚨 Exercise snacks: small bouts, big benefits 📈 NEW ... For people with insulin-dependent type 1 or type 2 diabetes, exercise snacks can serve as an alternative to taking a correction dose for high ...

5. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/sms.70114

Effects of Exercise Snacks on Cardiometabolic Health and ... Our findings suggest that ExSn can significantly improve cardiometabolic health by enhancing VO2max and PPO and decreasing TC and LDL-C. Notably ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8802999/

Exercise/Physical Activity in Individuals with Type 2 Diabetes Resistance exercise training in adults with T2D typically results in 10-15% improvements in strength, bone mineral density, blood pressure, lipid profiles, ...

7. withpower.com withpower.com/trial/phase-diabetes-mellitus-3-2024-988a8

Exercise Snacks for Type 2 Diabetes Exercise, including 'Exercise Snacks' or short bouts of activity, is generally safe for people with type 2 diabetes when done with proper guidance.

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4334091/

Effectiveness and Safety of High-Intensity Interval Training ... One low-volume HIIT protocol that has shown preliminary effectiveness in patients with type 2 diabetes involves 10 × 1-minute vigorous intensity efforts at ∼90% ...